Abdominal muscle cramps

I am a 54-year-old female who had gastric bypass (duodenal switch) surgery four years ago, followed 18 months later by major abdominoplasty, including tightening of abdominal ligaments.

I have been having very occasional (~1/wk) attacks of severe abdominal pain, which I first thought was intestinal but now feel is more likely abdominal muscle.  It is in the area at the bottom of the rib cage, lateral across the front.  The pain is so severe that I can barely speak, and makes postsurgical pain seem mild in comparison.  The attacks last about five minutes.  I can shorten them by taking deep abdominal breaths, and find I am more comfortable if I stand and extend my arms upward.  I hang my hands over the top of a door.  Since these have been occurring for three years, I have discovered they happen more often if I am taking certain drugs (Vicodin, citalopram), but they occur when I am not taking either of these.  They seem more likely to occur in the morning, but have woken me at night and have occurred at any time of day.  They are not related to eating, or to nausea, vomiting, or diarrhea--except that the pain is of such a severity to cause nausea.

I have discussed this with my surgeons, who said they would need to get an MRI while it is happening (impossible), and with my primary care physician, who defers to the surgeons.  I have had all kinds of vitamin and mineral level tests done post-surgery and have had any abnormalities corrected.  I have had electrolytes, thyroid, etc., checked several times during this period with no significant abnormalities.  I have not persisted with my physicians in diagnosing this since it has not gotten worse.  I have sort of assumed that those muscles that apparently are the cause are the same as the ones that hurt so much after the abdominoplasty that they had to give me muscle relaxants.  It hurt as they moved across my lower ribs when I breathed.

I have tried to figure out if this is a known syndrome, but I can't find anything about such a localized cramp.

Can you reassure me that this is a muscle cramp?  If so, is there anything I can do to prevent these attacks?  If not, is there anything I should be worried about?

Thanks.

[Kevin Pho, MD]

I can't give a definitive diagnosis without evaluation.

You can consider GI causes - like an ulcer, inflammation or GERD.  Evaluation of the upper digestive tract with an endoscopy can be considered.

Imaging the area would be helpful as well - including a CT scan.

If the initial tests come back negative, more specialized GI testing, including a gastric emptying scan, as well as 24-hr pH study with motility studies, can be considered.

If the GI system has been completely ruled out, you can look elsewhere - including cardiac, pulmonary, or musculoskeletal causes.

Discussion of these options can be made with your personal physician, or in conjunction with another opinion.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[steveftw]

I don't think this has anything to do w/your surgery.  Both my father (72) and I (51) have this disorder - or whatever - and have had it for years.  You describe it well.

Neither of us have had a gastric bypass although we are both candidates.

Did you have this before the surgery?